A comparative analysis of first trimester medical abortion in cases with previously scarred and non-scarred uterus: A case control study
Abstract
In recent years, termination of pregnancy has also become more common procedure due to intensive development of medicines and increasing demand for such procedures. In previously scarred uterus the use of medical abortion regimen could avoid severe complications such as uterine perforation, cervical laceration and other physical and psychological trauma which are caused by surgical termination of pregnancy. This prospective study was conducted in Department of Obstetrics and Gynaecology, J.L.N. Medical College, Ajmer from December 2015 to November 2017 to compare the efficacy, safety and acceptability of medical abortion in previously scarred and non-scarred uterus. For this study 75 women were included of amenorrhoea < 49 days with previous one or two LSCS (Lower segment cesarean section) and 75 women with no LSCS (primi and multipara with prior normal delivery). Regime which was used in this study was tab. Mifepristone 200 mg followed by Misoprostol 600µgm were given to them. Follow up was done at day 14 using sonography. The overall success rate for complete abortion in group I was 88% and that of group II was 89.3%.Total proportion of incomplete abortion was 9.33% in group I as compared to 8% in group II and continuation of pregnancy occurred 2.67% in both the groups during the entire study period. Thus there was no significant difference in efficacy of medicines in achieving abortion in scared and non-scared uterus. So early medical abortion represents an important method in previous scarred uterus patients having unwanted pregnancy. These regimens offer the prospect of a more private, less intrusive form of abortion that is both safe and effective.
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Introduction
In recent years, the caesarean section rate is increasing gradually in almost all countries of world. During the same time period, termination of pregnancy has also become more common procedure due to intensive development of medicines and increasing demand for such procedures.1
Consequently, a specific group of patients has emerged, namely those with a previous uterine scar who require termination of pregnancy.2 Pregnancy in the scarred uterus is a thorny situation in daily clinical work, especially in countries where the caesarean section rate is increasing. Serious complications in previous scarred uterus such as placenta previa and rupture of uterus are prone to take place following conception and consequently vacuum aspiration and curettage procedure increases morbidity and mortality by uterine perforation, serious hemorrhage and shock.3
Worldwide, an estimated 26 million pregnancies are terminated legally each year and 20 million are terminated illegally, with more than 78,000 deaths (2000).4
Conclusion
By carefully observing the results of the present study, it can be concluded that medical abortion is effective, safe and acceptable procedure upto < 49 days of gestational age for medical termination of pregnancy in previously scarred uterus and it can be offered as against the standard suction evacuation procedure that would require for an operative procedure, anaesthesia, a skilled surgeon and occupancy of a bed in hospital which significantly increases the cost of procedure as compared to the money spent in medical abortion. Medical abortion is a revolutionary technique. It is safe, efficacious, highly acceptable to women in both developed and developing countries. The availability of this low cost medical treatment using agents which do not require special cold storage and transport facilities may make the provision of safe abortion feasible in developing country settings where medical facilities are limited. The only limitation of this procedure is that it can be effectively given in early weeks of pregnancy.